Fill and Sign the Account Stated 497330292 Form

Account Stated for Construction Work Account stated made on the       day of       , 20       , between       of       , (Name of Owner) (Street Address, City, County, State, Zip Code) referred to herein as Owner, and       , a corporation (Name of Contractor) organized and existing under the laws of the state of       , with its (Name of State) principal office located at       , referred to herein as (Street Address, City, County, State, Zip Code) Contractor. Whereas, Contractor has furnished certain labor and materials described in detail in Exhibit A attached hereto for and in a certain building of Owner located at       , (Street Address)       , hereinafter called Building A, and for and in a certain (City, County, State, Zip Code) building of Owner located at       , hereinafter called (Street Address, City, County, State, Zip Code) Building B; Whereas, all construction required by agreement of the parties has been completed; and certain payments for labor and materials have been made by Owner to Contractor without specific designation as to which building the payments should be applied; Whereas, the parties desire to set forth the application of the payments and to set forth the status of the unpaid accounts due to Contractor; Now, therefore, for and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the parties agree as follows: 1. Allocation of Costs of Contractors. All of the charges of Contractor for labor and materials furnished in the construction for Building A will be marked as paid and satisfied in full. The charges for the construction performed in and for Building B are stated on the records of the Contractor to be $       . 2. Amount in Full Due Contractor. No payments have been made to Contractor for labor and materials furnished for and in connection with Building B, and there is now due to Contractor from Owner the sum of $       . Account Stated for Construction Work Page 1 of 2 WITNESS our signatures as of the day and date first above stated.       (Name of Contractor) By: By: (Signature of Owner) (Signature of Officer)             ( P rinted Name of Owner) (Title and Printed Name of Officer) Account Stated for Construction Work Page 2 of 2